III.—THE STORY OF THE LONG FIGHT FOR PURE WATER.
And now we come to the story of the long fight for pure water in Pittsburgh. The irony of the situation is, that there should ever have been a long fight in a city which has since 1863 publicly recognized the danger of impure water, the significance of which has almost continually been brought before the people by press and platform alike, for the past fifteen years. The story of the whole filtration movement cannot be separated from the story of the struggle for supremacy of contending factions in the dominant political party. And the result,—excess typhoid with its terrible cost,—becomes part of the penalty the city has had to pay for such corruption as the present graft proceedings in councils are bringing to light.
The situation at the beginning of the filtration movement in 1895-96 was this: One of the strongest political machines in the history of municipal government was in absolute control in Pittsburgh. It mattered not who was elected mayor; he had no responsible power. Heads of departments were appointed by outgoing councils. This meant that department heads held over, and used their power to re-elect as in-coming councilmen the outgoing councilmen who had elected them. Moreover, councils were controlled by the ring.[13] In this way the political machine was self-perpetuating. The directors of public works drew specifications for public improvements; councils awarded contracts; and it is a matter of notorious record that the well-known firm of which one of the ring leaders was a member usually secured the contracts.
[13] For an analysis of Pittsburgh politics during this period under the leadership of Magee and Flinn, see Lincoln Steffens's The Shame of the Cities.
The municipal election in February, 1896, was hard and bitterly fought. George W. Guthrie headed the reform party as candidate for mayor. According to one authority the majority of ballots cast were for Guthrie, but when the count came in officially a few days after election, the ring had won. With the mayor, both branches of councils, and the director of public works all of the dominant party, the carrying out of their ante-election pledges so far as filtration was concerned would seem a matter of course.
True to these pledges, a resolution for the appointment of a Filtration Commission, to include the mayor, the president of each council, and eight citizens,—making eleven in all,—passed City Councils on June 8, 1896, and was approved by the mayor on June 10.
The commission was promptly appointed and set to work to make a thorough investigation into the relative merits of various methods of filtration and water supplies in use in cities of the United States and Europe. Allen Hazen, a leading expert on filtration, was employed for the first phase of the investigation, and Prof. William T. Sedgwick of the Massachusetts Institute of Technology, eminent as a sanitary expert, investigated the typhoid situation in the city. Morris Knowles, C. E., was appointed resident engineer in local charge of all items of experiment and investigation. Various members of the commission visited European and American cities to study filtration methods; extended bacteriological and analytical studies of the Allegheny River water were made; small, slow, sand filter beds and standard make mechanical filters were set up at the experiment station to test the relative merits of each as applied to Allegheny River water; and nothing was left undone as a means of arriving at a sound conclusion. Over two and a half years elapsed between the appointment of the commission and the rendering of its report.
The report, which was very elaborate, was presented at a joint session of councils on February 6, 1899, and showed that the members of the commission were united in their belief that, all things taken into consideration, a slow, sand filtration plant should be constructed. In accordance with its recommendation steps were immediately taken for the issue and sale of bonds to provide the necessary funds, a public election for this purpose being held on September 19, 1899. The appropriation ordinance for the year 1900 contained "No. 100; for the purpose of extension and improvement of water supply and distribution, including the filtration of such water supply, and providing and furnishing meters to be used in connection therewith ... $2,500,000." The ordinance authorizing the controller to issue bonds for the purpose as above specified was passed by Select Council in March, and approved by the mayor April 3. So that prior to May 1, 1900, a fund of $2,500,000 became available, and the prospect for the prompt erection of the plant would have been bright, but for the fact that during the four years since 1896 certain changes in the attitude of the members of the ring toward one another had taken place, that were destined to involve further complications. One member (Magee) had aspirations toward the United States Senate. In this he encountered opposition from the other end of the state, and in the struggle for state supremacy that followed, Pittsburgh was left largely to another member of the ring.
In the early part of 1900 E. M. Bigelow, who for a long time had been director of public works, had a row with this leader (Flinn) over certain matters of public work. The result was that on June 11, 1900, the ring-controlled councils threw Mr. Bigelow out of office and elected as director of public works a man more friendly to the ring.
This break between Flinn and Bigelow was the beginning of the long series of events that retarded the filtration movement for at least four years.
Bigelow was now "out." The new director of public works, appointed by councils was acceptable to the ring that was "in"; so was the membership of councils. The question with Bigelow was, naturally, how to get back into office. This is the way he accomplished his desire. The ousted director had a brother, who, it is said, had an old grudge against the ring. He went to Harrisburg and prevailed upon the State Legislature to grant Pittsburgh a new charter, abolishing the office of mayor and substituting that of recorder, this office to be filled by the governor until April, 1903, when the regularly elected recorder would come into office. The charter also gave the recorder much larger powers than the mayor had previously enjoyed, among them the appointment of heads of departments and the right to enter into contracts hitherto the prerogative of councils alone.
As might be expected, the newly appointed recorder soon exercised the authority vested in him by the terms of the new charter, and on June 11, 1901, removed the head of the department of public works again installing Mr. Bigelow in that important position, just one year after he had been removed by councils.
It must be remembered that while Mr. Bigelow had again secured the directorship of the Department of Public Works, there had been no change in councils, which were still enrolled on the side of the ring. While councils could not now stop the preparation of plans and specifications for the proposed filtration plant, they could make a lot of trouble in other ways; and so they did.
There are contradictory statements at this time as to just how much progress had been made on plans during the year that Mr. Bigelow was out of office. One side claims that "sixty per cent of the plans had been drawn"; the other said, "only part of the plans." At any rate, within six weeks Mr. Bigelow removed the engineer who had served under his immediate predecessor, appointed as resident engineer Morris Knowles (who was later appointed chief engineer of the newly created Bureau of Filtration), and directed him to start work on plans for the filtration plant.
At the same time councils proceeded in an attack on the director for alleged delay in the preparation of plans; and on November 11, 1901, presented a report to its filtration committee declaring Mr. Bigelow entirely responsible for all the delay in the preparation of plans and specifications, adding that these delays had been "gross and inexcusable." This report was accompanied by a resolution ordering Director Bigelow to furnish within ten days, to the filtration committee, for its approval, all the plans and specifications for the work lying north of the Western Pennsylvania Railroad, directing him further to proceed with the utmost diligence to the completion of the plans and specifications for the remainder of the plant, and to submit the same to the filtration committee on or before December 2, 1901. The report and resolution were adopted by both councils on the day of their presentation. The real motive for this attack is readily inferred.
In the meantime the opposing faction had been working with the governor, and after a notorious meeting at the Duquesne club, the governor was prevailed upon to remove his first appointed recorder, on the pretext that he had displaced several old soldiers from office, and to appoint another recorder in his place,—this time a man upon whom the machine could rely. At the close of the letter of removal, the governor added a now famous postscript, "I was not bribed."
With the appointment of the new recorder, Bigelow was again forced out of the office of director of public works. This put the ring again in full control, with even greater powers than it had before. A year and a half had elapsed since the $2,500,000 became available, and all that the people had to show for it were eighty-five acres of land, part of the plans and specifications completed, and over 600 more deaths from the scourge of typhoid fever.
The next move was made within ten days after Director Bigelow's dismissal, when another ordinance for the letting of the contract was introduced. It quickly passed both councils and received the recorder's approval. By this ordinance the contract was not to exceed $1,500,000 and was to be for the construction of "so much of the filtration plant as is shown upon the drawings and description in the specifications, as and to be known as contract No. 1."
Under this ordinance the new director advertised for bids, which were received and opened. It appeared that the lowest bid was made by the T. A. Gillespie Company, at about $1,292,000. The director and recorder were preparing to let this contract for part of the work to the Gillespie Company, and it looked as though the faction of the ring now in the saddle would win the stakes.
But they had not reckoned all the odds. The opponents of the ring, in this two-sided hold-up game, brought out another winning card. It was in the person of John P. Edgar, a citizen of Steubenville, Ohio, but the owner of property in the thirty-seventh ward, Pittsburgh, who entered suit in the United States Circuit Court at Pittsburgh for an injunction to restrain the recorder and director of public works from awarding the contract. The case was argued before Judge Buffington on March 3, 1902, W. B. Rodgers and George W. Guthrie appearing for the plaintiff, and Thomas D. Carnahan, city solicitor, for the city. Suit was based on the allegation that no estimate had been presented to councils for the whole cost of the improvement, and that the letting of this partial contract would be in violation of the new charter, which required that before any contract for public improvement could be entered into, such an estimate for the entire cost must have been presented. The city solicitor showed that an estimate had been made of the entire cost, but this estimate had not been made public or submitted to councils. Mr. Rodgers maintained that this estimate must be submitted to councils and approved by them. He and Mr. Guthrie also claimed that the contract should embrace the completion of the work. On March 13, 1902, Judge Buffington issued the injunction prayed for. The court held that the estimate of the whole cost, required by the charter, must be made to councils and become a matter of public information, and that such an estimate had not been made.
The machine was temporarily blocked, but five days after the injunction had been granted, the recorder instructed his director of public works to have blueprints, plans and estimates of the entire filtration system ready to present to councils at as early a date as possible, thus starting the necessary legal steps for placing a new contract. Within a month these plans and estimates, involving an expenditure of $3,635,500, were prepared and submitted to councils, and three ordinances for the letting of contracts were presented. The increase over the first estimate was explained as due to an increase in the number of services to be metered, and to a general increase in the cost of materials.
These three ordinances were indefinitely postponed, however, in councils, because more money for the construction of the plant under the increased estimate was not available.
The next hold-up came from the city controller, who on May 1, 1902, sent the following letter in duplicate to Recorder Brown and Director McCandless:
In view of the uncertainty attending the proposed filtration of the water, and the doubt as to the ultimate disposition of the matter by councils, this department desires to notify you that on and after May 10, no indebtedness against that appropriation for any purpose, except for labor or supplies previously furnished, should be incurred, as, under the decision of the court, there is now no authority for any expenditure for filtration purposes.
In the meantime, about April, 1902, and all through that summer, advocates of a mountain water supply were at work. At the same time changes in councils threw out of the Filtration Committee members favoring sand filtration and elected opponents of the plan to its membership. The result was that on July 21, 1902, an ordinance was brought forward authorizing the Filtration Committee to prepare, in conjunction with the superintendent of the Bureau of Water Supply, or some other competent engineer designated by the director of public works, estimates showing the entire cost of the installation of the proposed sand filtration plant. Early in January, 1903, this resolution had passed both councils. It was, however, vetoed by the recorder on the ground that it was unnecessary, the Department of Public Works, he held, having already furnished full estimates, in good faith, and being ready to assist councils further in any manner that might be suggested. The recorder added in his veto: "If the purpose of this resolution is ultimately to defeat the proposed plan of sand filtration and substitute therefor a system of mechanical filtration, I am unalterably opposed to it." An attempt to pass the resolution over the recorder's veto was made, but it failed for lack of the necessary three-fifths vote.
In the meantime an ordinance was presented authorizing a public election for a bond issue large enough to cover the difference between the amount of money then available and the amount required under the increased estimate. All that came of this was an inquiry by the sub-committee to which it had been referred as to whether the new estimate included coverings for the filter beds, and whether the South Side was to be given filtered water. After ten months' further delay, this sub-committee reported that the estimate did not provide for covered filter beds and that it made no provision for the South Side. Another year and a half had elapsed, with 650 additional deaths from typhoid fever; 1,250 to date.
In April, 1903, by the election of Mayor Hays, the Bigelow faction again came into power and Mr. Bigelow was reappointed director of public works. Councils reorganized. A reform, or Bigelow man, was elected to the presidency of councils, control of committees was secured, and by the middle of 1903, the Bigelow faction was again in full power.
By this time the South Side was demanding filtered water. The new estimates presented by Director Bigelow in September, 1903, included ten filter beds for the South Side, and the raising of the pumping capacity for the first twenty-three wards by twenty million gallons, and included also, new machinery and boilers for the Brilliant pumping station, and a fifty-inch steel main across the city to supply the South Side and the Monongahela River wards of the old city. These brought the total new estimate up to over seven million dollars.
The time between September 21, 1903, and January 12, 1904, was required to get a resolution through councils and approved by the mayor, authorizing the finance committee to employ three experts, Col. Alexander M. Miller of Washington, John W. Hill of Philadelphia, and Rudolph Herring of New York, "to verify and make a report on or before March 1, 1904, to the committee on finance, as to the correctness of the estimates made by the director of public works."
Under this resolution the experts were employed and went to work. In the meantime, councils had received a petition from the Pittsburgh Section of the American Chemical Society, urging the establishment of a sand filtration plant; also a resolution of the Civic Club of Allegheny county, and a resolution of the permanent civic committee of the women's clubs of Allegheny county, urging sand filtration at an early date.
During 1903 there were 450 deaths from typhoid fever.
On February 27, 1904, the filtration experts made their report recommending a receiving basin, three sedimentation basins, a clear water basin, and forty filter beds. They also recommended sand filtration and covers for filter beds, but cut down the capacity of the various parts of the plant sufficiently to reduce the estimated cost by $700,000.
On March 31, 1904, the Bureau of Filtration in the Department of Public Works was created for the purpose of constructing these important works.
No further opposition of a serious character was met, and in July of that year a second bond election for $5,000,000 was held and passed by a vote of nearly two to one. These bonds were issued in September; plans and specifications for the enlarged plant were prepared as soon as possible; bids were advertised; and the contract was let on March 4, 1905.
With the final award of the contract the fight for pure water was practically won. Director Bigelow again stepped out of office in 1900 with the election of a mayor independent of either Republican faction; but the work of pushing the plant forward to completion was carried on by the Guthrie administration under the efficient supervision of Directors Clark and Shepherd, and Superintendent Knowles; so that by October, 1908, the plant was supplying a good quality of filtered water to the first twenty-three wards,—the old city.
The settling of the pending litigation between the city and the Monongahela and other private water companies on the South Side, together with the taking over of that property by the city was all that remained to be done before filtered water could be supplied to that part of the city.[14]
[14] In January, the Monongahela Water Company notified the city of its decision to abide by the decree of the Supreme Court, which granted permission to the city to take possession of this plant and system in consideration of $1,975,000.
In the meantime the North Side (Allegheny City) still has unfiltered water. Immediately after Allegheny was annexed to the Greater City in December, 1907, steps were taken to pave the way for filtered water there. $750,000 was appropriated for ten extra filter beds on city-owned land adjoining the plant, and their construction is now under way. Their use for the North Side involves extra pumping facilities, however. A plan to bring the old Allegheny pumping station at Montrose down to Aspinwall for this purpose was recently blocked by members of councils from the North Side. Satisfactory explanation for this action does not seem to be forthcoming. The reason alleged was that its removal would throw some of the men out of a job. In the meantime Allegheny continues drinking unfiltered water with no immediate prospect of relief, and the same sort of political influence that delayed filtration in the old city so long, seems to be accomplishing similar results on the North Side.
In conclusion, let me apply the economic facts brought out in the first section of this article, to the four years of unnecessary delays in the construction of the filtration plant, from April 3, 1900, to April 29, 1904. They must be considered in making up the whole bill of the city in the cause of pure water.
During all this time, more than $2,200,000, on which the city was paying three and one half per cent interest, was lying in the banks favored by the administration, bringing the city but two per cent; and the death rate from typhoid fever was the highest of any of the large cities in the United States. But for this delay the plant might have been brought to completion on January 1, 1904, or at least as far advanced as it was January 1, 1908, and four years,—1904, 1905, 1906 and 1907,—of excess typhoid fever might have been avoided. Not a startling statement, perhaps, on the face of it. But consider seriously what these four years of excess typhoid fever have meant to the people of Pittsburgh in deaths and economic cost. I have told you of but half of the people of six wards out of forty-three, one year out of four. In 1904, with an estimated population of 352,852, there were 503 deaths from typhoid in Pittsburgh. Cities with a fairly pure water supply do not have over twenty-five deaths annually per 100,000 population from typhoid. Had Pittsburgh's typhoid fever death rate in 1904 been twenty-five per 100,000, there would have been but 88 deaths instead of 503, and the grim total of 415 lives would not have been blotted out. By allowing $2,000 as the cost in loss of wages and expenses for each death (a little under the actual costs in the concrete study of economic cost already given), and allowing our previous minimum of $4,000 as the value of each life, the total excess deaths in 1904 alone from lack of pure water was a loss to the community of $2,490,000.
There were 425 unnecessary deaths in 1906, and a wastage of $2,550,000; 289 unnecessary deaths in 1905, and a wastage of $1,734,000; 415 unnecessary deaths in 1904, and a wastage of $2,490,000. In the four years the community lost $9,000,000,—over $4,000,000 more than the cost of the filtration plant. And in those four years, 1,538 lives were unnecessarily sacrificed.
There are those who will say, and perhaps rightly, that Pittsburgh's filtration plant of to-day is the magnificent triumph of construction that it is, only because of those years of delay in shaping the final plans; that while those who fought the measure tooth and nail for so many years did not have that purpose in mind, yet the set-backs they were able to accomplish, have made in the end for a larger, better, more efficient and more far-serving plant than could have been possible, had the first plans been carried hastily to completion. Such may be the case. If so, let the people be thankful that the cause of pure water triumphed ultimately over a lethargic public sentiment, selfish political purposes, and municipal shortsightedness. Let them at the same time remember at what cost to themselves and to their city the fight was won. And let the plant itself stand as an object lesson of tardy justice, and a monument to those hundreds of lives that paid the penalty unwillingly and unknowingly of being part and parcel of an unaroused municipal conscience.
GROSS NUMBER OF TYPHOID CASES, 1885 TO 1907.
[PITTSBURGH'S FOREGONE ASSET, THE PUBLIC HEALTH]
A RUNNING SUMMARY OF THE PRESENT ADMINISTRATIVE SITUATION
SAMUEL HOPKINS ADAMS
Starting at the lowest level, let us formulate our initial axiom in terms of dollars. A sound man can do more work than a sick man. Therefore he can make more money. A sound city can do more work than a sick city. Therefore, in the long run, it can accumulate more wealth. Public health is a public asset. This is a truth which, in her single-minded purpose of commercial and industrial expansion, Pittsburgh long ago forgot, if, indeed, she ever stopped to realize it. Consequently, at a time when all the other great American cities have organized their forces thoroughly and are waging battle, with greater or less scientific skill, against that most potent of all destroyers, the germ, this mighty aggregation of half a million human beings has only just declared war, and has barely established its outposts. After two years of preparation to meet conditions which have been half a century in forming and solidifying, Pittsburgh's little regular army of defence now faces the most complicated problem of municipal betterment to be found in American hygiene.
A health bureau performs a defensive and protective function. Its intelligence department must keep it apprised of every manifestation on the part of the enemy; and it must rally to the threatened point to check the advance before it be too late, whether the emergency be a school epidemic of diphtheria, or a localized onset of typhoid. It must maintain a jealous watchfulness over the food and water supplies that are brought into the city, lest with them shall come the invading diseases. And its statistics of death and disability must point out for repair, the breaches made in its walls by the never-ceasing onslaught. Such a sanitary garrison has little rest, and no respites, for the besieging germ never sleeps.
The date of Pittsburgh's last annual health report is 1899. That fact is crammed with meaning. Strategically it means that for nearly a decade the sentries have all been asleep at their posts. Politically it has meant that those responsible for the administration of the city were too lethargic, too ignorant, or too indifferent to disturb that profound Rip Van Winkleism. Civically it means "Who cares!", and that companion gem, "What's the use?". Between public indifference, private selfishness, and political inertia, the germ has pretty well had its own sweet way with Pittsburgh, and the city's annual waste of life from absolutely preventable disease has been a thing to make humanity shudder, had it been expressed in the lurid terms of battle, holocaust, or flood, instead of the dumbly accepted figures of tuberculosis, typhoid, and infant mortality.
Presumably, before this article gets into print, the Pittsburgh health report for the year 1907 will have been issued. What laborious exhumation of dilapidated statistical skeletons that report represents, I have not space to explain here. The important and significant point is that the authorities are at last at work, and energetically, under the leadership of a skilled sanitarian, Dr. James F. Edwards, superintendent of the Bureau of Health. It would be pleasant to add that Dr. Edwards goes into action with his hands free; pleasant, but quite untrue. On the contrary, he is bound and hampered to an extent that would devitalize the efforts of any but the most patient of enthusiasts. His forces are not under his own control, since under the Pennsylvania system he is at the head, not of a department, but of a bureau of the Department of Public Safety, administered by a layman. The law gives him no power to choose or discharge his own subordinates within the limits of the civil service; all that he can do is to train and educate such of them as most need it, when they come to him. He has no specific supervision or control over public or charitable institutions, those prolific culture-beds of contagion. Even the Municipal Hospital for Contagious Diseases has been taken out of his hands and put under other management. He cannot condemn a building inimical to the public safety, nor can he revoke a milk license. He cannot abate a nuisance without going to court for it. And, lest the powers of his bureau should wax too great and impinge upon individual privilege, old laws have been raked up and carefully interpreted to restrict the scope of its work. Yet in spite of all this, wonderful to say, the efforts of the bureau seem to have made an initial impress already on the death rate, and, even more important, to have gathered to its support some tangible force of public opinion.
"Seem to have made," I say, because figures in this connection are largely a matter of conjecture. Basis for any detailed comparison between present and past, is lacking. What is certain, however, is that the sanitary forces are doing work which must inevitably have its effect in life-saving in the future; and the efficacy, if not the qualitative result, of that work is hopefully apparent. The first attack was made on a condition of affairs which would have disgraced a country village, the prevalence of unprotected outhouses, scattered over the length and breadth of the landscape; not only lurking in the slums, but peering from the proud eminence of hilltops down upon the homes of wealth and elegance below.
Through the agency of flies in summer and of wind or heavy rains in winter, these relics of communal barbarity spread filth and contagion through the city. How many of them existed at their maximum will never be known. There are still six thousand survivors, but the number is being reduced daily. Proceeding under an ordinance which declares them illegal, Dr. Edwards began his campaign modestly. Opposition he foresaw, but he waited to keep it, as far as might be, sporadic, and to prevent it from concentrating. In the year 1905 only forty-six of these nuisances had been abolished. In 1906, six hundred of them fell. Thereupon the sensitive nerve of property rights thrilled the alarm throughout the commercial body. Reform was threatening rental profits; was becoming "radical," and "destructive." People with pulls, real or imagined, rushed to councils with demands for the repeal of the ordinance. But here an unexpected ally appeared. Destruction of the old meant construction of the new and modern, with much accruing increment to the plumbing trade. Therefore these shrewd business sanitarians hastened before the committee with lawyers and arguments, and so effectually backed up the case of the Health Bureau, that the repeal project was killed then and there. In the enthusiasm of well-won victory plumbers' supplies soared heavenward, with the result of bringing the unfortunate property owners down upon the Bureau of Health in agonized droves, begging for protection from the masters of the situation. Thereupon the bureau quietly allowed an extension of time, until the enthusiastic plumbers, somewhat chastened, saw the point and came nearer to earth in their prices; after which the process continued, and has been continuing, with accelerated progress. For the issue had now been decided. The proprietors of noisome property had lost the first skirmish. In 1907, 7,755 notices were served on recalcitrants, and 3,590 privies were abolished. By the end of 1910, Dr. Edwards hopes to have relegated these nuisances to a purely historical status.
Encouraged, the Bureau of Health sought from the Legislature the power to condemn unsanitary dwellings. At present, in order to destroy property prejudicial to the public health, the bureau must go to court and prove the conditions unsanitary,—a cumbrous, expensive, and uncertain process. It is not long since a presumably upright and intelligent occupant of the bench held that a house which leaked so badly that the floors were rotted and the plaster peeled from the walls could not, on that account, be adjudged unsanitary. The bill passed the Legislature, prescribing condemnatory powers, with a proviso for court review and damages to the owner if the condemnation should be found unjustified. Governor Stuart vetoed the bill on the ground that it was too sweeping. If the local undertakers haven't passed a vote of thanks to the governor, they have missed a gracious opportunity. What would have been the one most effectual check upon the city's mortality, the wiping out of those death-in-life conditions of housing which make for tuberculosis, the active contagions, and above all the undermined vitality represented in Pittsburgh statistics under every division from general debility to suicide,—that the gubernatorial veto has effectually blocked. So certain large and small owners of slum property have an extension of immunity for their rentals drawn, at the worst, from premises where they wouldn't house their pigs,—particularly if they designed to eat the pigs afterward.
Evil housing conditions are almost invariably reflected in the mortality figures of tuberculosis. Yet Pittsburgh's given death rate from tuberculosis is low; hardly half the normal rate for American cities, in general: so low, indeed, that I doubt whether any sanitarian would give implicit credence to it. Similarly, the death rate from pneumonia and bronchitis is suspiciously high. For example, in 1907 there were a quarter as many deaths attributed to bronchitis, as to consumption, an incredible assumption. Dr. Matson, who is in charge of the bureau's statistics, has decided, with a wisdom born of experience, to regard fatal cases of bronchitis as belonging, statistically, in the pneumonia column; so I shall lump the two diseases. In the first eight months of last year (which is as far as the monthly figures have been supplied to me) there were but 565 deaths set down to tuberculosis in all forms, whereas the pneumonia and bronchitis totals aggregated upwards of 1,100. This is a condition which, so far as I know, has never been paralleled in any American city. The inference is inevitable that deaths, which should properly be ascribed to the great white plague, are reported by physicians under other heads. This is due, usually, to the influence of the decedent's family, who fear to lose their places if it be known that there is "consumption in the house," or who will perhaps, forfeit the insurance money if the true cause of death appear on the records. Very wisely Dr. Edwards is proceeding, not upon local certificates, which may lie, but upon universally recognized facts, which cannot; and is planning an exhaustive tuberculosis campaign. In this campaign will be concentrated the local official health force, the Pittsburgh Tuberculosis League, and the local dispensary of the State Board of Health, all working in conjunction with a special Tuberculosis Commission now in process of organization by the city government.
At present the consumptive poor of Pittsburgh have a small, practically a negligible chance of life. The great, rich, busy city that slowly kills them, has no means to care for them while they are dying. There is no municipal tuberculosis hospital. To be sure, Marshalsea, outside the city, can care for some thirty victims; but they are taken there, usually, only when they are too weak to resist effectually. For Marshalsea is the Poor House. And there is inbred in the American an indestructible, illogical, pathetically self-respecting something which makes the term "Poor House" a poison to his soul. Live he might, within those walls. He prefers to stay outside and die. The late Dr. Charles Harrington of the Massachusetts department, wisest and most human of health officials, said to me once in one of his characteristic bursts of impatience with the stupidity of Things as they Are:
"If I had the choice to make between naming a refuge for the helpless sick 'Poor-house' or 'Sure-Death,' I'd choose 'Sure-Death' every time. You could get more people to go to it."
Marshalsea doesn't save many of the consumptives who come to its gates. Non-consumptives it does save, indirectly, since it removes from a susceptible environment, a certain number of spreaders of infection. Private effort does its altruistic but minute best in Pittsburgh; the Tuberculosis League has a hospital in which it can take care of fifty to sixty patients. And the State Board of Health relieves the situation a little by maintaining one of its admirable tuberculosis dispensaries in the city, with a staff of visiting nurses; and sends a few hopeful cases to its sanatoriums. Perhaps 100 victims of the plague can be cared for in proper institutions. There are to-day in the city probably 3,000 sufferers in a sufficiently advanced stage to be a peril to all with whom they come into contact. At a very moderate estimate three-fifths of this number are unable to afford proper home care, and of this three-fifths (all of whom will die, barring the few that can be accommodated in the hospitals) probably one-third,—again my estimate is conservative,—could be saved under proper conditions. That is, Pittsburgh of the mighty mills, Pittsburgh of the heaped-up millions, Pittsburgh of the rampant industrialism which has spread its influence to the far corners of the world, stands by helpless while six hundred lives are going out needlessly, not because they might not be saved, but because there is no place in which to save them. Nor is this the worst; since, in the slow process of dying, these victims will radiate the poison to hundreds, directly; indirectly to thousands, who are now well, strong, and unsuspecting the inevitable doom. What can the Health Bureau, the officially constituted army of defence, do to remedy this condition? Nothing. That is the answer which goes over the telephone wires, once, twice, half a dozen times a day, to people who ask for advice for helpless cases of consumption. I suppose that the sorriest duty of a health official, is to deny the application of some man upon whose life depends the support of other lives, for a fighting chance to get well and do his work in the world. Ask Dr. Edwards, oh comfortable resident Pittsburgher, how often he has had to do the very thing in the last year. It may give you new light on your civic responsibilities.
Not so often will that hopeless response be made in the future. The united forces, drawn together by the forming Tuberculosis Commission, will make it their first business to provide some refuge of increasing adequacy, for those who are now distributing the infection. Meantime, though there is little to be done for those already stricken, the city is being covered, district by district, by the visiting nurses of the league, of the State Dispensary and of the Health Bureau, soon to be re-enforced by five special nurses from the commission, and all training and instructing the consumptive in those measures of prevention which safeguard the people about him from contracting the disease.
One-third of all who die in Pittsburgh, die without having anything to say about it. That is, they die under five years of age. One-fourth of all who die, die without having anything to say about anything. That is, they die under one year of age. Most of these deaths are preventable, being the outcome of conditions which, humanly speaking, have no right to exist. Chief among the causes is bad milk. Pittsburgh uses 40,000 gallons of milk per day, coming from a wide radius in both Pennsylvania and Ohio. Before the present administration, this vitally important merchandise received rather less attention than the corner-stand vending of collar buttons. At the beginning of 1906 the Bureau of Health had one lone milk inspector. He collected samples, and, if one may judge by the brief records of analyses, he didn't imperil his own health by over-assiduity in the job. Dairy inspection was an unthought-of phase of activity. In August, 1906, two more inspectors were acquired and began, by prosecutions, to do some work in the matter of discouraging the use of formaldehyde. There was even some inspection of stores and adjacent dairies. Now the bureau has six men in the milk division, two of whom are dairy inspectors and one a veterinarian, and all of whom do conscientiously the work the city pays them to do. Two more have been arranged for, with which addition Dr. Edwards believes he will have a sufficient force to inaugurate a higher standard of supply. Unfortunately there is no official standard, though an ordinance is being prepared establishing bacterial and temperature requirements. Unfortunately, too, the law has been interpreted to mean that the Bureau of Health must issue licenses on demand; and that it cannot revoke these licenses. What has been done thus far is chiefly in the line of educating the dairymen and dealers. Dr. Edwards admits frankly that, while he regards pasteurization as a make-shift only, he believes that it will be necessary for a time to accept the deteriorated quality of milk consequent upon pasteurization, for the sake of destroying the pathogenic bacteria with which the supply swarms. Analyses made last summer showed an average of a million bacteria per cubic centimetre. The limit of reasonable safety is usually set at half that number.
As for conditions as they existed at that time in certain local dairies, I can do no better than quote from the report of Dr. Goler, the health officer of Rochester and an international authority on milk supply:
Go out to one of those dairies near the country club which supplies milk to some of the families living in the best localities and see the conditions under which milk is produced for the future citizens of the state and the nation. A dirty one-room house that once did duty as an out-house, supplied with water by a hose, a few old tubs in which cans, bottles and utensils are washed in cold water, and where all the waste flows into a vault beneath the foundation of the house. A damp, dark, old stable festooned with cobwebs, without drainage, where all the liquid refuse finds its way through cracks in the floor to the space beneath the structure, and where, on filthy floors, in some cases raised but one poor plank above the common floor of the stable, the swill-fed cows stand and give milk for some of the babies of Pittsburgh aristocracy, whose parents are willing to pay the munificent sum of eight cents a quart for the product.
Visit cow stable after cow stable within easy motor ride from Pittsburgh, and the conditions of filthiness prevailing in the stables are only exceeded by the depth of manure and mud in the barnyards.
The conditions of the cows, cans, utensils and barnyards at the distant points from which the city draws its milk may be judged by the fact that they pasteurize the milk before bringing it to the city and pasteurize it again before it is sent out from the dairy.
Dairy inspection, it is fair to say, has recently ameliorated the worst of these conditions. Increasingly careful supervision of the retail milk dealers, and constant inspection of the less cleanly stores, which has discouraged many of them out of existence, tend to minimize the danger of contamination of milk at the other end of the line. There is, however, an additional peril in the well-water supply often used to wash cans and bottles.
The milk-inspection force faces a situation outlined in the latest complete figures (not yet in print); those for 1907, which show a total infant mortality of more than a thousand from diseases inferentially due to bad milk. The poorer quarters of the city where prices rule at six or seven cents a quart, exhibit the heaviest figures, and there is the typical rising curve of the mortality line in hot weather. Last summer that curve, while still unpleasantly in evidence, was noticeably modified. Education of mothers of the slums was largely responsible. The Bureau of Health put a corps of six special nurses in the field who went about from house to house, instructing mothers in the hygienic care of their children, and working in conjunction with the Pittsburgh and Allegheny Milk and Ice Association, one of the most efficient charitable enterprises in the city. Probably the infant mortality for the whole year of 1908 would have been low but for the winter epidemic of measles, which killed more victims than scarlet fever, diphtheria, smallpox, chickenpox, and all the other active contagions put together. Now the city, having learned a costly lesson in the seriousness of this too commonly disregarded disease, quarantines for it. It is perhaps, hardly ingenuous to include smallpox in the foregoing comparison, as that disease is now a practically negligible quantity. Since the epidemic of 1903 Pittsburgh has been the best vaccinated of American cities. Wherefrom depends a corollary for the consideration of the anti-vaccinationists, that for two years there has not been a death from this loathsome and unnecessary infection in the city, nor has a single original case developed.
DISEASE-INCUBATORS.
Some Pittsburgh cow-stables which lower the standards set by progressive producers.
We are prone, in this country, to study the public health too much in terms of death rates, and too little in the character of the survivors. Applying this latter test to the children of Pittsburgh's slums, we shall find cause to wonder whether, in a sense, the deaths are not too few rather than too many. Would it not be better for the unfortunate and innocent victims themselves, and certainly for the community at large, that this puny, helpless breed of hunger, filth, and misery which creeps about the city's man-made jungles, should succumb in infancy to the conditions that bred but cannot support them? For there are certain phases of existence in which a high death rate is less to be feared than a high birth rate. Anti-race-suicide has a fine, rotund ring, as it issues from the presidential lips. But President Roosevelt has never, I take it, been in Mulberry Alley, or Our Alley, or a certain unnamed court off Washington street that wafts its stenches into the boulevard below, or any one of a score of other hopeless thoroughfares which might give him pause in the promulgation of his doctrine.
Nor are conditions of life here in the city's choked up center greatly worse than in the "runs" which diversify the landscape of the newer parts of the city; damp, heavy-aired, steaming canyons, into which the poorest classes have been pushed; over the rim, and "off the earth," as it were. There they live, pasty women and weazened children, in the heavy air, polluted, as like as not, by the stenches from the creeks which are little else but open sewers. One such little isolated population I found, in a huddle of houses, under a towering steel bridge, faithfully reproducing, in what was practically open country, the deadliest living conditions of the crowded center of population.
To return to the central slums, there are whole districts which might well (were it of any avail) be placarded, as are certain New York flats:
No Room Here For Children.
Settlement workers know the truth about this matter. Here are the words of one of them:
"Not one child in ten comes to us from the river-bottom section without a blood or skin disease, usually of long standing. Not one out of ten comes to us physically up to the normal for his or her age. Worse than that, few of them are up to the mental standard, and an increasing percentage are imbecile."
What can a Bureau of Health do to
(By permission of the Pittsburgh Bureau of Health).
WHERE HUMAN LIFE IS CHEAP.
alleviate such a status? Nothing: the problem is too big for official solution. Either a sense of responsibility on the part of the mill owner toward his employes who must live near the mills will start a housing movement that will do away with the present outrageous rentals for disgraceful accommodations, or an aroused public conscience will, by one means or another, make a clean sweep of these pest holes. Or, a third, and ugly alternative. London's East End is open for the inspection of travelling Pittsburghers. There they may see in its fullness the crop of pauperism, dependence, and degeneracy which is bred in the third and fourth generations, of conditions no worse than their own average, and not so bad as their own worst.
As an escape from the slum there is the school. Here again Pittsburgh is in the dark ages of hygiene. Every public school is a law unto itself. The principal, always a layman, and not unusually an ignorant one in health matters, decides when a pupil shall be isolated for a contagious or suspicious ailment. Is it surprising that a short time ago a certain skin disease infected an entire institution, or that eye and scalp ailments are often widely diffused among the scholars? From an inspection of buildings and pupils Dr. Goler draws these conclusions:
The school buildings are in many cases crowded, dark, dirty, often of three stories, and bad fire risks. The condition of the children in these schools good and bad, rich and poor, may be shown by the large proportion having defective teeth, reduced hearing, imperfect vision. An excessively large number of them are mouth breathers, partially so because they are unable to breathe through their noses in the smoky air of Pittsburgh, and a very considerable number are below stature for weight of that determined for the average child. In a large percentage, the defects of teeth, nose and throat, bring them below the physical normal. These are the children that wear out in childhood.
PSEUDO-RELIGIOUS 10-CENT LODGING HOUSE.
In cellar of river-front building; flooded out every year. Dilapidated, unsanitary and unventilated, this and similar lodging houses were breeding place of disease. Closed by Bureau of Health, following investigation and report for Pittsburgh Survey, by James Forbes, mendicancy expert of the New York Charity Organization Society. A lodging house code has since been established.
In no manner of justice, can the Bureau of Health be held to account in this matter. In co-operation with the Civic Club, settlements, physicians and school principals, Dr. Edwards sought to establish a medical inspection of public schools, such an inspection as would, for example, undoubtedly have checked almost at its inception the disastrous onset of measles of last year. But the measure never got past the legal department of the city administration. In view of the present conditions in the schools, Dr. Goler's closing and pregnant suggestion has a special force:
"Ought not the Pittsburgh schools to be closed and the children repaired?"
Semi-public institutions in Pittsburgh are quite independent of hygienic control or inspection. This seems to me one of the crying evils of the present status. Let me give a few examples: An inmate of an institution for children was infected by another child who had virulent skin disease and soon afterward he became totally blind. This was a repetition of a past experience of the same institution in which a child contracted trachoma within the institution walls, is totally blind in consequence and a charge upon the state.
Last spring an institution was found in charge of a matron whose special qualification for her care of very young children was experience. She had had ten of her own, all of whom died of intestinal disease and rickets in early childhood. She was feeding the little ones in her care on coffee and other food suited only to robust grownups. Every child in a certain charitable institution, a short time ago, was suffering from skin and scalp disease. Lack of arrangements for effective isolation, in case of contagious disease, is more common than provision for isolation. A refuge for fallen women has, naturally, a large percentage of inmates suffering from venereal disease. The women of one refuge work in the laundry which gets a certain amount of outside trade. Among other things it washes towels for a hotel. Contraction of gonorrhea or syphilis from infected towels or garments is a well-recognized medical fact. A laundry with infected women on its working force cannot but be a public peril.
Grim facts are piling up on the records of the Pittsburgh Tuberculosis Dispensary as to advanced cases of tuberculosis among the little charges of charitable institutions.
Instances such as these might be multiplied. As in the case of the public schools the authorities are helpless. Even over the city's own institution, the Municipal Hospital, the Bureau of Health has no control. It has been transferred to the Bureau of Charities within the last year. It receives only contagious diseases, and is too small for the requirements in time of epidemic, having proper accommodation for only eighty, with a crowded capacity of 125. Dr. Booth of the Bureau of Health, who acts as visiting physician by special appointment to the Bureau of Charities, tells me that up to 1905 the plant was housed in buildings erected in the seventies. The furnishings were beds and bedding from the fire and police departments, regarded as being no longer fit for use by the city's paid servants, and therefore proper charity for the city's helpless sick. Two years ago, Dr. Booth put an end to this system by burning the last consignment of furnishings (for reasons principally entomological); and announcing that he would admit to the hospital no more equipment, discarded as unfit by the police and fire forces. Now the plant has its own furnishings. The building is modern but of an obsolete and unsatisfactory type, and has not sufficient grounds for its convalescents. All the other hospitals in the city are private institutions. There is no co-ordination of hospital work among them, and their distribution is such that localities where there are the most ambulance calls are without easily available hospital plants.
To sum up, these are some few of Pittsburgh's immediate needs, if it is to fight its battle successfully for fewer deaths and a better living product:
Autonomy of the official health authorities (preferably a department of health, not a bureau) under the executive and administrative control of a physician or sanitarian.
A tuberculosis hospital for advanced cases which are now spreading infection throughout the city. More visiting nurses and more sanitary inspectors. Eventually a hospital for the incipient cases that can be saved.
Municipal collection and disposal of the rubbish which accumulates everywhere, seriously hampering efforts to make the city hygienically clean and which must now be removed at private expense.
A general hospital of sufficient size, proper equipment, and adequate surroundings.
Some reasonable division and co-ordination of effort on the part of the private hospitals.
Authority to condemn and destroy unsanitary buildings.
Authority to condemn and destroy, upon its entrance to the city, or upon discovery within the city limits, unclean, infected, or adulterated milk, and to refuse and revoke milk licenses. Establishment of a standard for milk.
Medical inspection of schools and school children.
Medical and sanitary inspection of hospitals, and of all public or semi-public chartered institutions.
These authorizations to be embodied in a city code. At present the health officials work almost wholly under the state law.
GERM HATCHERIES. THESE FRONT ON THE GRANT BOULEVARD.
What is Pittsburgh going to do about it? Though the foregoing rather general survey may suggest pessimistically "the little done, the undone vast," yet there is not lacking, in the view, definite promise as well as progress. Many and diverse agencies are helping the cause. The monthly reports of the bureau keep a public, which has for years been in a state of Egyptian darkness as to the how and wherefore of its mortality, fully informed. A Civic Improvement Commission has been appointed by Mayor Guthrie, one of the sub-committees of which will deal with needed hygienic reforms. The Chamber of Commerce has appointed a special committee to co-operate with the Health Bureau for the betterment of housing conditions, and another to aid in improving the milk supply. For the protection of the communities downstream, a sewage disposal plant has been voted; and badly needed it is, as is shown by the fact that, at the present writing, two thousand people are ill in the suburb of Bellevue, from drinking water polluted by Pittsburgh's sewage. The Allegheny County Medical Society has constituted a committee on public instruction in health matters; also a milk commission. The Tuberculosis Commission will soon be in the field with its broad campaign. Municipally there has been an important step forward in the establishment of a disinfection corps which sterilizes and makes safe, at the public expense if necessary, the premises from which a consumptive has been removed. Anti-tuberculosis education by the various corps of visiting nurses is extending into every corner of the city that harbors a dangerous consumptive. The state school commission has recommended medical inspection of schools. City ordinances providing for milk standards, and rubbish disposal, are in prospect. The Bureau of Health, only a short time ago a rusted and ineffectual machine fed by incompetents from other departments, has, under its new head, developed an esprit de corps, and is now welded into a compact, dependable organization. And this organization will constantly have a supply of better trained men to draw upon, since the University of Pittsburgh and the Carnegie Technical Schools have, at Dr. Edwards's suggestion, arranged for special courses in sanitary engineering and practical hygiene.
Yes; Pittsburgh is awake to the needs of the situation. But the true test is yet to come. Thus far it has been but the laying out of the lines of battle and a few preliminary, and, on the whole, victorious skirmishes. For when hygienic and sanitary reform impinges, in its advance, as it needs must, upon the private purse of some, the political purposes of others, and the industrial and commercial license of the whole, then will come the tug of war. Then, according as shortsighted selfishness shall prevail over, or succumb to, civic pride and patriotism, the victory will be to the germ or to the city.
A SLUM IN THE OPEN.
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Transcriber's Notes:
Simple spelling, grammar, and typographical errors were corrected.
Multiple underscores indicate a long gap in the sentence.